Healthcare Provider Details

I. General information

NPI: 1548246713
Provider Name (Legal Business Name): JOSEPH BIANCARELLI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2005
Last Update Date: 12/04/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 LINCOLN AVE
CARBONDALE PA
18407-2170
US

IV. Provider business mailing address

66 WEST GILBERT STREET 2ND FLOOR
RED BANK NJ
07701-4918
US

V. Phone/Fax

Practice location:
  • Phone: 570-281-1004
  • Fax:
Mailing address:
  • Phone: 732-212-0051
  • Fax: 732-212-0713

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD056700L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD056700L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: